AHIP Urge Senate to Keep Protections for Patients With Pre-Existing Conditions

May 25, 2017

As Senate Republicans draft an ACA replacement bill, America’s Health Insurance Plans (AHIP) urged Senate leaders to maintain protections for individuals with pre-existing conditions previously set forth under the ACA.

“While certain modifications to existing rules are needed (eg, such as greater state flexibility to adopt wider age-bands to make coverage more affordable for younger adults), we believe that core insurance market reforms that guarantee access to affordable coverage for those with pre-existing conditions should be retained, including guaranteed issue, community rating, and barring pre-existing condition exclusions,” Marilyn Tavenner, president and CEO of AHIP, wrote in the letter.

Under the current rules of the ACA, insurers cannot deny coverage or charge more for individuals based on pre-existing conditions. AHIP explained to Senate Republicans that insurers do not want to go back to the rules that existed prior to the ACA. Instead, insurers want to maintain the protections currently set in place.

Unlike the rules of the ACA, the AHCA would allow states to waive the community rating protection, meaning insurers would have the ability to charge sick patients a higher premium—which could price many patients with preexisting conditions out of coverage.

As the new bill continues to be drafted, many physician and hospital groups have expressed their opposition; they say that many individuals will lose coverage under the new bill. While the AHIP has yet to oppose the House bill, they have expressed concerns directly to the Senate.

According to the letter, another issue facing many insurers is the fate of cost-sharing reductions. Because President Trump has threatened to cancel them, insurers are urging Congress to guarantee funding for these payments, or insurers will have to increase premiums by 15% to 20%.  

Further, AHIP continued to warn Senate Republicans that a new cap on Medicaid payments in the House bill could impact the coverage and care provided to beneficiaries.

“We are concerned that key components of the proposed new funding formulas in the AHCA… could result in unnecessary disruptions in the coverage and care beneficiaries depend on,” AHIP wrote. “Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts.”

Julie Gould (Mazurkiewicz)